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Diabetic foot ulcers (DFUs) affect nearly 25% of diabetics.  Nearly 85% of amputations are preceded by foot ulcers and studies suggest that 25-50% of the costs related to inpatient diabetes care is directly related to DFUs.  Given the high prevalence, severity, costs, and morbidity of diabetic foot complications, one would expect that federal funding for DFU research would be proportionate to its public health impact.  A recent publication in Diabetes Care highlights the disparity between research and NIH funding and the costs of care for DFUs.  The number of peer-reviewed DFU publications increased 78% between 1980–1989 and 2000–2009, similar to the number of total diabetes publications, which increased 72% over the same time.  Of 22,531 NIH-funded diabetes research projects between 2002-2011, only 33 (0.15%) were specific to diabetes, counting for 0.17% of total NIH diabetes funding.  The math yields a 604-fold difference between overall diabetes funding and that for DFUs.

Remarkably, as highlighted in the publication, no U.S. Food and Drug Administration–approved products or medical devices for patients with neuroischemic diabetic foot ulcers are currently available as these patients are frequently excluded from clinical study programs.  We’ve previously highlighted this statement in some previous posts and discussed potential new therapies on the horizon, including Heberprot-P, an interesting epidermal growth factor-based treatment for DFUs: http://insightmechanics.com/2012/11/14/diabetic-foot-ulcers-new-hope/

 

The publication is available free online at: http://care.diabetesjournals.org/content/36/7/1815.full

 

RLS: Tied to Mortality in Men

RLS has been in the news this week.  The study, “Prospective study of restless legs syndrome and mortality among men,”  was published in Neurology last week. by Dr. Xiang Gao, a Harvard Epidemiologist and Dr. John Winkelman, a leading expert in the RLS field.  This was a prospective study of over 18,000 US men free of diabetes, arthritis, and renal failure in the Health Professionals Follow-up Study, of which 3.7% met the IRLSSG criteria for RLS at baseline.  2,765 deaths were reported during the 8-year follow up period (2002-2010).  RLS was associated with a 39% increased risk of mortality, with a hazard ratio of 1.39.  This association was slightly diminished after adjustment for BMI, lifestyle factors, chronic conditions, sleep duration, and other sleep-related disorders (Hazard Ratio 1.3).  After further excluding those with major chronic conditions such as cancer and hypertension, the hazard ratio increased to 1.92 (each hazard ratio described here was statistically significant).  Thus, men with RLS had a higher overall mortality and this association was independent of known risk factors, such as older age, weight, sleep duration and smoking. The increased mortality in RLS was more frequently associated with respiratory disease, endocrine disease, nutritional and metabolic disease, and immunologic disorders.  F0r more on this study, check out the article at: http://neurology.org/content/early/2013/06/12/WNL.0b013e318297eee0

… or this piece in U.S. News and World Report: http://health.usnews.com/health-news/news/articles/2013/06/12/restless-legs-syndrome-tied-to-earlier-death-risk

 

 

A new population based study published in the Journal of Clinical Oncology and conducted by the National Cancer Institute on patients with newly diagnosed myeloma shows how initial myeloma treatment has moved from mostly traditional chemotherapy to novel therapies in less than 10 years. The percentage of patients receiving novel agents rose  from approximately 4% in 1999 to 76% in 2007. During the same time frame, the use of conventional chemotherapy (melphalan, vincristine and doxorubicin) decreased significantly. In addition, researchers determined that the combination of novel agents, chemotherapy, and a transplant became more common over time (from 0.6 percent to 18 percent). The percent of hematopoetic stem cell transplants (HSCT) also doubled during this period from approximately 11% to  22%.

Additional trends uncovered were the variations in use of novel treatments and HSCT by race and type of insurance. For white patients, use of novel agents was lower for those with Medicare only (42.6%) than for those with private insurance (50.2%). For patients of other races, those with Medicare only or Medicaid were less likely to receive novel agents or transplantation compared with those with private insurance. The researchers postulate that the high out of pocket costs for Medicare patients  on myeloma medications (around 20%) is a likely factor driving this trend.

While the rate of transplant went up, it is still considered quite low. The authors offer two potential explanations: Either providers were relying on older clinical data on the benefit of transplant over chemo, or the  number of transplant eligible patients is increasing with the advent of more effective novel front-line agents.

The abstract can be viewed here: http://jco.ascopubs.org/content/early/2013/04/08/JCO.2012.46.3323.abstract

 

A recent imaging study published in Brain Connectivity by Martha Holmes and colleagues from Vanderbilt University, links decreased brain cell concentration to altered functional connectivity in temporal lobe epilepsy, which involves seizures typically originating in the hippocampus.  Voxel-wise linear regression analysis was used in the study between grey matter concentration maps and whole-brain resting connectivity maps in 15 patients with left temporal lobe epilepsy.  In total, 20 regions exhibited grey matter concentration decreases linearly correlated with resting-state functional connectivity to either the left hippocampus or the left thalamus in the patient group only.

 

For more on this interesting study, check out:   http://online.liebertpub.com/doi/abs/10.1089/brain.2012.0103

 

A recent Norwegian study published in JAMA Neurology provides evidence supporting the notion that mild cognitive impairment at the time of Parkinson’s disease (PD) diagnosis is correlated with an increased risk for early dementia.  They study included 182 PD patients followed for three years.  27% of the PD patient cohort with mild cognitive impairment progressed to dementia than the cohort without the impairment.  Mild cognitive impairment at the one-year visit was also associated with a 28% progression rate to dementia and 20% reversion rate to normal cognition.  Of the patients with persistent mild cognitive impairment at baseline and the one-year visit, nearly 50% developed dementia.  Though cognitive impairment in PD is common, and is also hypothesized to be linked in some cases to medication, this study strengthens the needs to assess these symptoms at each visit.

 

For more information, check out the article at: http://archneur.jamanetwork.com/article.aspx?articleid=1671737

PatientsLikeMe has been awarded a $1.9 million grant from the Robert Wood Johnson Foundation (RWJF) to create the world’s first open-participation research platform for the development of patient-centered health outcome measures.  This new platform will allow health outcome measures to better reflect the patient-disease experience, unmet needs, and assess quality of life.   PatientsLikeMe is a well-established network for patients who want to monitor their health, improve their outcomes, and contribute to medical research and discovery.  The PatientsLikeMe network covers over 200,000 patients over 1,500 diseases.  Researchers will be able to attract PatientsLikeMe members to their studies, track progress, and export data for analysis, ensuring rapid feedback from the patient.  An important aspect of this program will be patient measurement, and PatientsLikeMe will be contributing dozen of existing instruments they have developed.

 

For more information on the initiative: http://rwjf.org/en/about-rwjf/newsroom/newsroom-content/2013/02/rwjf-awards-grant-to-patientslikeme.html

Detailed information on the diseases and therapies covered by PatientsLikeMe can be found at:

http://www.patientslikeme.com/conditions/

http://www.patientslikeme.com/treatments/

 

This week, the Food and Drug Administration approved the Argus II Retinal Prosthesis System as the first treatment for retinitis pigmentosa, a genetically-inherited disorder causing the breakdown of cells in the retina.

File:My eye.jpgThe implantable device includes a small video camera and transmitter mounted within a pair of glasses. The images from the camera and converted to electronic data that is then wirelessly transmitted to electrodes implanted in the retina.  The Argus II system allows for a significant improvement in vision in patients who untreated may go blind.  Nearly 100,000 patients are afflicted with the disorder.  Second Sight Medical Products hopes to gain additional indications for a variety of vision disorders, including macular degeneration. This is one company to watch moving forward.

 

For more information, check out: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm339824.htm

http://2-sight.eu/en/product-en

Many may have seen IBM’s Watson supercomputer beat Jeopardy on TV a few years ago.  Since, Watson has been working with WellPoint and the Memorial Sloan-Kettering Cancer Center, learning and analyzing clinical oncology data.   After “learning” 600,000 pieces of medical evidence and 2 million pages of text from clinical oncology trials, Watson now has the knowledge to streamline the review processes between physicians and the patient’s health plan.  Furthermore, the IBM Watson Cancer Diagnosis and Treatment Adviser uses physician input via EMR, which Watson then analyzes taking into account data published in medical journals, industry association guidelines, and specific hospital best practices.
File:IBM Watson.PNG

Clinicians at Memorial Sloan-Kettering have been training Watson to extract and interpret physician notes, lab results, and clinical research.  Within minutes, Watson provides treatment options and suggests tests, as well as compiling a list of ongoing clinical trials the patient may be eligible for.  Given the sheer volume of clinical trial and medical data that may be pertinent to each case, Watson provides a service to all facets of the healthcare industry, maximizing the potential for quality- and value-based healthcare.

Check out more at:

http://www.informationweek.com/healthcare/clinical-systems/ibm-watson-helps-doctors-fight-cancer/240148236

This past week, L&M Healthcare joined the Multiple Myeloma Research Foundation (MMRF) PowerTeam for the ‘Empire State Building Run-Up’ on February 6th.  L&M sponsored three staff members to run the most famous building in New York City. The L&M team consisted of Mike Stefanik-Strategic Account Director (middle), Alexis Rolla- Strategic Account Coordinator (right), and Heather Clancy- Speakers’ Bureau Coordinator (left).

ESR Group

All money raised went to the Multiple Myeloma Research Foundation (MMRF), the world’s largest private funder of myeloma research. An outstanding 90% of all funds raised went toward research and related programming.

When the gun went off, a wave of 100 MMRF athletes dashed through the staircase door and up 86 flights of stairs in the Empire State Building Run-Up. A quick 1,576 steps will get you from the ground floor to the final lap around the Observation Deck that looms nearly a quarter mile above 5th Avenue.

Not only did these three athletes get a chance to participate in this unique marquis event, but they earned the bragging rights that they conquered the world’s most famous ‘vertical marathon’. Each finisher was awarded a special NYRR “Empire Run Up” medal, a rare addition to even the most die-hard runner’s medal collection!

A recent article published in PLoS ONE by researchers at the University of Pittsburgh School of Medicine describes how a 30-year-old paralyzed man used a brain-computer interface via an electrode array sitting on top of his brain to control and actuate movement.  This enabled him to move a robotic arm and touch the hand of a friend, the first time he was able to do this in seven years.  The brain-computer interface encompassed a postage stamp-sized electrocortigraphy grid consisting of 28 recording electrodes on the surface of the brain, and wires from the device were implanted under the skin of the neck and then to a computer.  His thoughts were interpreted by computer algorithms and then translated into movement of a computer cursor and then a robotic arm.  In terms of neurophysiology, the patient was able to voluntarily activate the sensorimotor cortex with distinct cortical activity patterns for different segments of the upper limb.  The article further details the learning and training process.

Check out more on this incredible story at:  http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0055344

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